Write an executive summary that outlines the government’s impact on health reform in the U.S. healthcare delivery system. As part of your executive summary, also provide a brief analysis of the ethical principles that must be addressed within health reform in order to create a more equitable healthcare system.
Your essay should be a minimum of two pages in length. Any sources used should be cited and referenced in APA format.
PRICE IS FIRM WITH BUDGET
I NEED A RESPONSE FOR THIS ASSIGNMENT
1 PAGE
3 REFERENCES
ZERO PLAGIARISM
There are a few questions that come to mind when reading this case. One of the things that stood out was the fact that the patient does not see her father a lot. If possible, I would want to speak with her father to find out if the types of behaviors described by the teacher and mother also exist when the patient is with him. This would give me a more holistic view of the patient’s behavior. For example, the diagnosis may change if the patient does not act this way when her father is present.
The timeline of the patient’s tantrums is not very clear, and I would ask her mother to clarify them. She states that the patient has had tantrums since age 5, but then states that she has been resentful since her younger sister was born (they are two years apart). She also states that her tantrums are improving. I would like to know if this is really related to the birth of her sister, or if other factors contributed to her behavior. Was her behavior influenced by her belief that her mother’s attention had to be shared? Was she showing signs of being angry or resentful toward her mom before her sister was born?
Finally, I would also speak with the child’s grandmother to see if she too shares the same feelings about the child’s behavior. Is the child “negative” and defiant with her? Does she seem difficult to deal with as well? This will help me to see if the child’s behavior is the same in all settings or if she is deliberately this way with certain people. Once again, this may alter her diagnosis.
People to Speak with in the Patient’s Life
As previously stated, the persons I would like to speak with (besides her mother and teacher) are her father, grandmother, and sister. These are three people at different ages who interact with the patient in different settings and may be able to provide other perspectives not given by the mother or teacher.
Physical Exam and Diagnostic Tests
While there is no specific test to diagnose ADHD, the DSM-V lists that criteria that the child or adolescent must meet in order to be diagnosed with this condition (Felt et al., 2014). It is also important to note that there are other conditions that may mimic and/ or coexist with ADHD. These include anxiety disorder, autism spectrum disorders, fetal alcohol syndrome, hearing loss, intellectual disability, mood disorder, oppositional defiant disorder (ODD), sleep disorder and speech and language disorder and finally, problems with hearing or vision (Felt et al., 2014). Behavioral rating scales are also used in the assessment of ADHD. There are several but Conner’s scale was used in this scenario.
Differential Diagnoses
Three differential diagnoses include:
The differential diagnosis I believe most suitable for this patient with ADHD comorbid with disruptive mood dysregulation disorder (DMDD). While the ADHD symptoms are clear with this patient, there are other behaviors that may suggest DMDD. These include, irritability, anger, and temper outbursts (National Institute of Mental Health (NIMH), 2017); all of which have been described by the teacher and her mother. Trouble functioning due to irritability has also been described by both the patient’s mother and teacher, which is another criterion for this diagnosis (NIMH, 2017).
Pharmacologic Agents
Extended-release stimulants are the first-line treatment for children with ADHD (Brown et al., 2018). Either Methylphenidate or Amphetamine should be chosen and depending on how the patient tolerates the drug, as well as how well their symptoms improve will depend on dosing. This patient was initially given D-methylphenidate, however, she had insomnia and her ODD symptoms persisted and as a result the medication had to be changed. Lisdexamfetamine (Vyvanse) proved to be the most beneficial for this client.
Lessons Learned
Treating a child with ADHD can be tricky. There are several different preparations that one must consider before initiating treatment. I also noted that while stimulants are good for treating ADHD and ODD, in this case, polypharmacy was more beneficial as there were no changes with her ODD symptoms until guanfacine was added. These cases have shown me how imperative it is to get complete assessment before diagnosing so that nothing (or very little) will be missed. Ruling out other possible neurodevelopmental disorders is essential so that treatment can be efficient and accurate.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Brown, K. A., Samuel, S., & Patel, D. R. (2018, January). Pharmacologic management of
attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational Pedicatrics, 7(1), 36-47. doi:10.21037/tp.2017.08.02
Conduct Disorder. (2018, June). In American Academy of Child and Adolescent Psychiatry.
Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Conduct-Disorder-033.aspx
Disruptive Mood Dysregulation Disorder. (2017, January). In National Institute of Mental
Health. Retrieved from https://www.nimh.nih.gov/health/topics/disruptive-mood-dysregulation-disorder-dmdd/disruptive-mood-dysregulation-disorder.shtml
Disruptive Mood Dysregulation Disorder (DMDD). (2019, May). In American Academy of
Child and Adolescent Psychiatry. Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Disruptive-Mood-Dysregulation-Disorder-_DMDD_-110.aspx
Felt, B. T., Biermann, B., Christner, J. G., Kochhar, P., & Van Harrison, R. (2014, October 1).
Diagnosis and Management of ADHD in Children. American Family Physician, 90(7), 456-464. Retrieved from https://www.aafp.org/afp/2014/1001/p456.html
Stahl, S. M. (2017). Essential Psychopharmacology Prescriber’s Guide (6th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications (4th ed.). New York, NY: Cambridge University Press.
Federalism’s Impact on Policy
The fragmentation of the U.S. health care system, with its differing modes of financing and service delivery, is a reflection of a dispersed government structure. Policy making is shared and distributed across various branches and levels of government. As a result, policy making processes can be slow to respond, manipulated towards personal interests, and often redundant. Consider, for example, the public entitlement programs such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS), and the PPACA of 2010. Where is there overlap between these policies? How do they demonstrate a dispersed government structure?
This week, you will analyze the role of the federal government in health care policy making.
To prepare:
By tomorrow 04/17/2018 3pm, write a minimum of 550 words in APA format with at least 3 scholarly references from the list of required readings below. Include the level one headings as numbered below:
Post a cohesive response that addresses the following:
1) Provide an example of two policies that address similar needs, passed at two levels of government (i.e., federal, state, or local).
2) What are the advantages and/or disadvantages of this duplication? How does this example reflect the implications of federalism? Provide support from the literature for your position.
3) To what degree should the federal government get involved in health care policy making? Provide concrete examples to support your position.
Required Readings
Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.
Chapter 15 discusses the history of legislating national health care insurance in the United States. The chapter focuses on the different methods of financing a national health care reform, from a single-payer government fund to employer and individual mandates.
Chapter 16 highlights the historical relationships between health care purchasers, insurers, providers, and suppliers. Over the decades, these stakeholders have battled for control of the U. S. health care system, as health care costs increase, and more people remain uninsured.
France, C. (2008). The form and context of federalism: Meaning for health care financing. Journal of Health Politics, Policy & Law, 33(4), 649–705. doi: 10.1215/03616878-2008-012
The author argues that the United States’ unique form of federalism works negatively within a fragmented societal context to create an equally fragmented and dispersed health care system. The article highlights the United States health care system by comparing it with systems in Canada, Germany, and Australia.
Frankel, M. S. (2009). Commentary: Public outreach by the FDA: Evaluating oversight of human drugs and medical devices. Journal of Law, Medicine & Ethics, 37(4), 625–628.
Kennedy, E. M. (2005). The role of the federal government in eliminating health disparities. Health Affairs, 24(2), 425–428.
In this article, the late Senator Kennedy discusses health care disparities among marginalized groups in the United States. He proposes the expansion of Medicaid and State Children’s Health Insurance Program (SCHIP), increased cultural competency among health care providers, health care research related to marginalized groups, and an increased public health investment by the United States. He includes a brief history of government involvement in reducing health care disparities.
Grading Criteria:
Grading will be based on the depth and accuracy of your answer. The following points will be used to assess this assignment. Please familiarize yourself with it and do not hesitate to refer back to it before, during, and after composing your answer.
For the Final Project II: Bioethics, you will analyze the Terri Schiavo case through the lens of bioethics. You will find resources to help get you started on the case in this week’s module resources and the case is also referenced in chapter 13 of your textbook.
To complete this assignment, review the Milestone Three Guideline and Rubric sheet attached below.
PLEASE respond to paper answering all questions provided within the rubric atached below and the Terri Case attached!
Review the Schiavo case as covered by the New York Times. Also watch the video (12:57) included with the article.
Terri Schiavo Documentary: The Case’s Enduring Legacy (13:06)
Question 1: Monumental Architecture and Sculpture
The cultures we studied this week produced architecture, earthworks, and monumental sculpture, in addition to smaller works of art. Using your course textbook locate three examples of architecture, earthworks or monumental sculpture from three different cultures listed here: Islamic, Chinese, Japanese, or the Americas.
First, completely identify each structure or sculpture you would like to discuss by listing its name, date, and location.
In a minimum of 3 well-developed paragraphs address the following questions:
Who created each work of architecture or sculpture? Who commissioned its creation?
What historical events or social or cultural influences affected the creation of each work?
How do the visual characteristics of each work contribute to or enhance its message or meaning?
Be sure to explain your ideas clearly and support them by discussing specific details about each work of architecture or monumental sculpture.
Question 2: The Function of Art Objects
Some of the art objects created by the cultures surveyed this week served functional roles in their society. Using your course textbook locate three such objects, one each from the following: Islamic, Asian (Chinese or Japanese), and African.
First, completely identify each object you would like to discuss by listing its name, date, and location.
In a minimum of 2 well-developed paragraphs discuss:
What was the function of each object at the time of its creation?
What historical events or social or cultural influences affected the creation of each work?
How do the visual characteristics of each object contribute to or enhance our understanding of its meaning?
Be sure to explain your ideas clearly and support them by discussing specific details about each work.
Respond to both questions as thoroughly as possible, making sure to use information from the readings and the lectures. All responses should be in complete sentence form, using proper spelling and grammar.
NRS 410V Module 2 Approach to Care
Pathophysiology and Nursing Management of Clients Health -Genetic Alterations and Cancer
Write a paper (1,250-1,750 words) describing the approach to care of cancer. In addition, include the following in your paper:
1. Describe the diagnosis and staging of cancer.
2. Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
WHAT I NEED IS 1 REPLY COMMENT PER POST, EACH COMMENT NEEDS TWO HAVE TWO APA REFERENCE ABOVE 2013 WITH CITATION.
POST1
The selected case for this discussion is case number five which involves sleepy woman with anxiety.
The three questions to ask the patient
a. Does anxiety interfere with your ability to concentrate?
The choice for this question is based on the fact that anxiety can send one into a true tailspin of disruptive and irrational thinking which interferes with the ability to focus
b. Which medication did you use for narcolepsy?
The question will help in determining if the drugs used to treat past narcolepsy was effective to avoid possible onset.
c. Do you experience headache, dizziness, nausea, vomiting, constipation or dry mouth?
The question will help determine if the patient is responding positively to bupropion. These are some of the side effects of bupropion and therefore, persistent of these symptoms would mean the patient is not responding well to bupropion
The people in the patient’s life to speak to or get feedback from for further assessment of the patient’s situation
a. The husband: How do you describe the sleeping pattern of your wife?
The question will help in determining if the patient is having sleeping disorder, that is, excessive sleep.
b. Former class teacher: How do you describe the concentration of the patient while in class?
Lack of concentration is one of symptoms of sleep apnea and therefore, the question will determine if the patient has recurring sleep apnea.
The physical exams and diagnostic tests that would be appropriate for the patient and the use of the results
I will perform physical exam to look for signs and symptoms of anxiety such as nervousness, restlessness, panics, rapid heartrate and weakness and lethargy. The result will be used to determine severity of the anxiety disorder and consequently helps in selecting the most effective medication. I will also use the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). I will also use polysomnography to monitors heart, lung and brain activity, breathing pattern to help in ruling the presence of absence of sleep apnea (Mokhlesi & Cifu, 2017).
The three differential diagnoses for the patient
The first differential diagnosis is anxiety disorder. The patient presents symptoms of anxiety such as excessive sleep during the day.
The second differential diagnosis could be sleep apnea. This order can make one to feel tired and unrefreshed. During the day, one may feel fatigued and experiencing difficulty concentrating or unintentionally fall asleep. Further, obstructive sleep apnea is the most likely differential diagnosis for this patient. This is because obstructive sleep apnea is associated with excessive daytime sleep just like evidenced in the patient.
The third differential diagnosis is narcolepsy. The past medical history of the patients showed that she had been diagnosed with narcolepsy and therefore, it is possible that the patient has another onset of narcolepsy.
Hypersomnia is another possible condition of the patient because she is having or excessive sleepiness. The patient has trouble staying awake during the day. Insomnia is another possible condition as the patient has daytime impairment related daytime sleepiness (Ardani et al. 2016).
Two pharmacologic agents and their dosing appropriate for the patient’s sleep/wake therapy
The first pharmacologic agent that would be appropriate for the patient’s sleep/wake therapy by considering that the patient has narcolepsy is to start initial dosage of amphetamines at 10 mg orally per day in divided doses. The medication will be used induce daytime alertness because the patient is experiencing excessive sleep which is a symptom of obstructive sleep apnea. The second pharmacologic agent that would be appropriate for the patient’s sleep/wake therapy is gabapentin. The medication is useful in patients with restless leg syndrome and insomnia just like the patient in the case study. The dosage for gabapentin would be 600 mg orally once daily together with food (Schroeck et al. 2016).
Therapeutic changes and check point
The following for this client based on amphetamines dosage, the daily dose will be raised in 10 mg increments at weekly intervals up to the point when the optimal response is achieved.
The “lessons learned” from the case study
One of the challenges in the case is to use effective drug to treat resistant anxious depression while taking into consideration excessive sleep symptoms. A comprehension of the electrophysiologic, as well as, neurochemical that correlates with the stages of sleep is necessary in defining sleep disorders. Just like evidenced in the patient, excessive daytime sleepiness is normally associated with disorders such as obstructive sleep apnea and depression.
References
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Ardani, A. R., Saghebi, S. A., Nahidi, M., & Zeynalian, F. (2016). Does abstinence resolve poor sleep quality in former methamphetamine dependents?. Sleep Science (sao Paulo, Brazil), 9, 3.
Schroeck, J. L., Ford, J., Conway, E. L., Kurtzhalts, K. E., Gee, M. E., Vollmer, K. A., & Mergenhagen, K. A. (November 01, 2016). Review of Safety and Efficacy of Sleep Medicines in Older Adults. Clinical Therapeutics, 38, 11, 2340-2372.
Mokhlesi, B., & Cifu, A. S. (2017). Diagnostic Testing for Obstructive Sleep Apnea in Adults. Jama, 318, 20, 2035.
POST2
Case 1: Volume 2, Case #16: The woman who liked late-night TV
I would ask the following questions from the patient
The case reveals that patient’s husband died many years ago. This is an open ended question to ask about changes in patient’s life after the death of her husband. May be she feels lonely, maybe she does not have someone to listen to her views. Spending such a life for years might have resulted in symptoms of depression. Social isolation affects behavioral health in elderly people. It contributes to depression and sleep disturbance (Choi, et al., 2015).
Depression and sleep problems are often associated with stress. Sleep disturbances often occur during high-stress periods (Schlarb, et al., 2017). This question access if patient’s sadness and sleep issues are due to stress in her life. May be feels stressful about something in her life. May be to deal with stress she prefer to watch TC until late at night.
The case reveal that patient has a chief complaint of being sad. She is also expected to have a cochlear implant in future. This question access if her sadness issue is related to her hearing issue. The answer to this question would reveal if patient’s hearing problem is the reason behind her sadness or there is something else.
I would ask specific questions and would take specific feedback from patient’s son. The case reveal that patient has a son who visits him often but does not live with her. Patient is 70-year-old, is elderly and has hearing issues. Asking the following questions from her son would be helpful to understand her problem in detail
The above mentioned questions would provide useful insight to evaluate the health condition, past life condition and social life of the patient. I would indicate when the patient’s problem started.
Patient is an elderly and wants support from her love one still her son does not live with him. The other person caring for patient is her aide and I would also ask from questions from her to access patient’s condition and underlying problems more accurately.
These questions would help analyze the relationship between patient and her aide. Patient is taken care by her aide. At this point we do not know the behavior of her aide. These questions are important to access if aide is caring for her in the right manner or she is not taking care of the patient.
A complete physical exam would be performed for the patient. Patient has depression, sleeping problems and leg ache. Physical exam would help determine if physical problems or weakness are the underlying cause of these problems. An eye exam would also be performed during physical exam to access why the patient is having the issue of tears in her eyes. Her eye problem would be accessed and appropriate eye drops would be prescribed. Thyroid test would be important to access the level of thyroid hormone in the body. This is because thyroid hormonal level is found to have a relationship with depression (Dayan & Panicker, 2013). Iron level test would also be needed to identify if inadequate levels of iron in the body are causing of restless leg syndrome (Cochrane, 2016). DSM-5 criteria would be used to determine the patient’s mental health problem and diagnosis.
Based upon the signs and symptoms and patient’s condition revealed in the given case, following are the three differential diagnosis for the patient
Restless Legs Syndrome (RLS):
This condition also called Willis-Ekbom Disease causes unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them. Symptoms commonly occur in the late afternoon or in evening hours, and are often most severe at night when a person is resting such as lying or sitting (Guo, et al., 2017). Symptoms may also occur when someone remains in an inactive position for a long period of time for instance when sitting in an airplane for long hour or watching a movie. The intensity of symptoms in increased during night time and therefore it is often difficult to sleep at night or return to sleep after waking up.
Restless leg syndrome is the most likely diagnosis for the patient. This is because patient has complaints of ‘ache and jump’ and due to this condition she is unable to fall asleep at night.
Insomnia:
Insomnia is the most common sleep complaint. This condition occur when someone has trouble falling asleep or staying asleep even though he has the opportunity to get a full night of sleep. The symptoms, causes and severity of insomnia vary from person to person. Symptoms of the condition may include difficulty falling asleep; waking up too early in the morning; difficulty staying asleep throughout the night (Singh, 2016). In the current case, patient reports problem with sleeping, she has difficulty falling asleep at night. Therefore, the differential diagnosis for insomnia is included.
Obstructive Sleep Apnea (OSA):
This is a potentially serious sleep disorder. It causes breathing to repeatedly stop and start during sleep. There are several types of sleep apnea, but the most common type is obstructive sleep apnea. This condition occurs when the throat muscles intermittently relax and block the airway during sleep. A noticeable sign of obstructive sleep apnea is snoring (Foroughi, et al., 2016).
In the current case, patient might also be suffering from this disorder because she reported snoring during sleep.
At this point, it can be inferred that patient is having comorbid medical conditions including restless leg syndrome and obstructive sleep apnea. These two conditions are affecting her sleep pattern and due to lack of quality sleep she might be having depressive symptoms. Sleep problems often result in depressive problems (Luca et al., 2013)
The two pharmacologic agents that would be appropriate for the patient include:
Modafinil is a wake-promoting agent approved for the treatment of excessive sleepiness associated with shift work disorder, obstructive sleep apnea (OSA) and narcolepsy (Stahl, 2014). This drug would be helpful for patient in controlling her problem of obstructive sleep apnea (OSA) that is causing her issues of snoring. The current dose of modafinil prescribed to the patient is 400 mg/day. This dose is the full dose. However, I would not prescribe full dose to the patient considering her age and possible side effects of the medicine at full dose.
Mirapex is prescribed for treatment of restless legs syndrome and Parkinson’s disease. The medicine can improve symptoms of restless legs syndrome and Parkinson’s disease and can improve sleep (Stahl, 2014). The medicine should be started at lowest dose (0.125 mg) and increased necessary every 5 to 7 days until symptoms are controlled (Stahl, 2014). Therefore, for the treatment of RLS, Mirapex would be prescribed to the patient.
A potential mistake or medical prescription error I noted in the case was that at second interim follow up Celexa was increased to 30 mg/day. However, maximum dose of Celexa for elderly is 20 mg/day (Stahl, 2014). Considering the age of patient, I would have not increased the dose to 30 mg/day. Another issue that I noted in the case was that patient did not agree for CPAP in repeated visits. I would have researched for new generation CPAP equipment and would have motivated the patient for CPAP treatment.
Through the case study I learnt how the symptoms of multiple conditions overlap and create difficulty for patient’s to cope up with the symptoms. This case also though to how to use polypharmacy for patients suffering from a number of sleep problems. In the current case, patient has suffering from restless leg syndrome and obsessive sleep apnea. For OSB, CPAP treatment was recommended for the patient which she denied. If I would be in a similar situation in my clinical practice, I would try to convince my patient for CPAP treatment. If however, patient would not agree then I would consider other treatment options.
Choi, H., Irwin, M. R., & Cho, H. J. (2015). Impact of social isolation on behavioral health in elderly: Systematic review. World Journal of Psychiatry, 5(4), 432-436. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4694557/
Cochrane. (2016). Iron for restless legs syndrome. Retrieved from https://www.cochrane.org/CD007834/MOVEMENT_iron-for-restless-legs-syndrome
Dayan, C. M., & Panicker, V. (2013). Hypothyroidism and depression. European Thyroid Journal, 2(3), 168-179. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017747/
Foroughi, M., Razavi, H., Malekmohammad, M., Naghan, P. A., & Jamaati, H. (2016). Diagnosis of Obstructive sleep apnea syndrome in adults: A brief review of existing data for practice in Iran. Tanaffos, 15(2), 70-80. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127617/
Guo, S., Huang, J., Jiang, H., Han, C., Li, J., Xu, X., & Wang, T. (2017). Restless Legs Syndrome: From pathophysiology to clinical diagnosis and management. Frontiers in Aging Neuroscience, 9(1), 171-182. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454050/
Luca, A., Luca, M., & Calandra, C. (2013). Sleep disorders and depression: Brief review of the literature, case report, and nonpharmacologic interventions for depression. Clinical Interventions in Aging, 8(1), 1033-1042. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760296/
Schlarb, A. A., Claßen, M., Grünwald, J., & Vögele, C. (2017). Sleep disturbances and mental strain in university students: Results from an online survey in Luxembourg and Germany. International journal of mental health systems, 11(1), 24-29. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372247/
Singh, P. (2016). Insomnia: A sleep disorder: Its causes, symptoms and treatments. International Journal of Medical and Health Research, 2(10), 37-41.
Stahl, S. M. (2014). The prescriber’s guide. New York, NY: Cambridge University Press. Retrieved from https://stahlonline-cambridge-org.ezp.waldenulibrary.org/prescribers_drug.jsf?page=9781316618134c114.html.therapeutics&name=SERTRALINE&title=Therapeutics
Mary is a 35 years old electrical engineer who presents to the office for evaluation of a rash on her face that has been present for 1 week. She denies new soaps, detergents, lotions, environmental exposures, medications, and foods. The rash is across her face and the bridge of her nose. She states that she first noticed it after spending a week hiking and camping in the Appalachians. The lesions itch and are painful. She has not tried anything to make it better, but she has noticed that going outdoors makes it worse. She denies any spread of the rash to other areas. She has never had this rash before.
She has noticed some increased fatigue, fever, and weight loss. She denies headache, sore throat, ear pain, nasal or sinus congestion, chest pain, shortness of breath, cough, abdominal pain, and pain with urination, constipation, or diarrhea. She does have mouth soreness. She has noticed some increased muscle aches and pains, which are worse in the hand and wrist. She denies early morning joint stiffness or difficulty with being able to move in the morning. She denies temperature intolerance, polyuria, polydipsia, or polyphagia.
She had a tonsillectomy at age 9 for chronic strep throat infections. She has been healthy as an adult. She has never had children. She has never been hospitalized for any reason.
Her family history is significant for a mother with rheumatoid arthritis. Her father is healthy.
She does not smoke; she drinks a glass of wine nearly every night with her dinner; she denies illicit drug use. She completed a master’s degree in engineering. She has lived with her boyfriend for the past 5 years.
Patient is an alert young woman, sitting comfortably on the examination table. BP 112/66 mm Hg; HR 62 BPM and regular; respiratory rate 12 breaths/min; temperature 100.3°F. Several erythematous plaques scattered over the cheeks and the bridge of nose, sparing the nasolabial folds. Normocephalic, atraumatic. Sclera white, conjunctivae clear; pupils constrict from 4 mm to 2 mm and equal, round, and reactive to light and accommodation. Oropharynx moist with erythema in the posterior pharyngeal wall; no exudates; shallow ulcers in the buccal mucosa bilaterally. Neck supple without cervical lymphadenopathy or thyromegaly. Full range of motion; no swelling or deformity; muscles with normal bulk and tone.
Instructions:
Make a whole history and physical examination in a comprehensive manner with all its elements included: CC, HPI, PMH, FH, SH, MEDICATIONS, ALLERGIES, ROS PER APPARATUS OR SYSTEMNS, HEAD TO TOE PHYSIACL EXAMINATION PER SYSTEMS ( write your presentation in H&P format no paragraph format).
Based on this information, what is your presumptive nursing diagnosis? All nursing diagnosis that apply to the case written in NANDA format related to … and evidence by…., NO MEDICAL DIAGNOSIS.
Teaching plan and nursing care plan per each nursing diagnosis on this case.
Requirements.
1- All written assignment and documentations must be in APA 6th edition format.
2- Double spaces, minimum 4 pages long , minimum 3 up to date bibliography. (UP to date means last 3 years.), Note: you can use your test book as bibliography too, bibliography have to be written in APA format.
1. Question: The coronary ostia are located in the:
2. Question: Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants?
3. Question: Decreased lung compliance means that the lungs are demonstrating which characteristic?
4. Question: What is the life span of an erythrocyte (in days)?
5. Question: Infants are most susceptible to significant losses in total body water because of an infant’s:
6. Question: Causes of hyperkalemia include:
7. Question: Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?
8. Question: The lung is innervated by the parasympathetic nervous system via which nerve?
9. Question: When an individual aspirates food particles, where would the nurse expect to hear decreased or absent breath sounds?
10. Question: Which T-lymphocyte phenotype is the key determinant of childhood asthma?
11. Question: What is the final stage of the infectious process?
12. Question: How is most of the oxygen in the blood transported?
13. Question: When a patient has small, vesicular lesions that last between 10 and 20 days, which sexually transmitted infection is suspected?
14. Question: An individual is more susceptible to infections of mucous membranes when he or she has a seriously low level of which immunoglobulin antibody?
15. Question: Which congenital heart defects occur in trisomy 13, trisomy 18, and Down syndrome?
16. Question: What is the functional unit of the kidney called?
17. Question: Which of the following is classified as a megaloblastic anemia?
18. Question: What are the abnormalities in cytokines found in children with cystic fibrosis (CF)?
19. Question: The only surface inside the nephron where cells are covered with microvilli to increase the reabsorptive surface area is called the:
20. Question: Between which months of age does sudden infant death syndrome (SIDS) most often occur?
21. Question: What is the primary site for uncomplicated local gonococci infections in men?
22. Question: Which organism is a common sexually transmitted bacterial infection?
23. Question: The drug heparin acts in hemostasis by which processes?
24. Question: What is the primary cause of respiratory distress syndrome (RDS) of the newborn?
25. Question: An infant has a loud, harsh, holosystolic murmur and systolic thrill that can be detected at the left lower sternal border that radiates to the neck. These clinical findings are consistent with which congenital heart defect?
26. Question: Hemolytic disease of the newborn (HDN) can occur if the mother:
27. Question: Blood vessels of the kidneys are innervated by the:
28. Question: What is the most common cause of insufficient erythropoiesis in children?
29. Question: If the sinoatrial (SA) node fails, then at what rate (depolarizations per minute) can the atrioventricular (AV) node depolarize?
30. Question: Hypersensitivity is best defined as a(an):
31. Question: Which criterion is used to confirm a diagnosis of asthma in an 8-year-old child?
32. Question: How is most carbon dioxide (CO2) in the blood transported?
33. Question: When the bladder accumulates 250 to 300 ml of urine, it contracts and the internal urethral sphincter relaxes through activation of the spinal reflex arc (known as the micturition reflex).
34. Question: Which cells have phagocytic properties similar to monocytes and contract like smooth muscles cells, thereby influencing the glomerular filtration rate?
35. Question: Which statement best describes a Schilling test?
36. Question: Fetal hematopoiesis occurs in which structure?
37. Question: Which disorder results in decreased erythrocytes and platelets with changes in leukocytes and has clinical manifestations of pallor, fatigue, petechiae, purpura, bleeding, and fever?
38. Question: What is the life span of platelets (in days)?
39. Question: What is the ratio of coronary capillaries to cardiac muscle cells?
40. Question: Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen?
41. Question: The most common site of metastasis for a patient diagnosed with prostate cancer is which location?
42. Question: During an IgE-mediated hypersensitivity reaction, which leukocyte is activated?
43. Question: In which primary immune deficiency is there a partial-to-complete absence of T-cell immunity?
44. Question: Innervation of the bladder and internal urethral sphincter is supplied by which nerves?
45. Question: What effects do exercise and body position have on renal blood flow?
46. Question: Which blood cell type is elevated at birth but decreases to adult levels during the first year of life?
47. Question: It has been determined that a tumor is in stage 2. What is the meaning of this finding?
48. Question: Research supports the premise that exercise has a probable impact on reducing the risk of which cancer?
49. Question: Where in the respiratory tract do the majority of foreign objects aspirated by children finally lodge?
50. Question: What is the most common cause of iron deficiency anemia (IDA)?
51. Question: Which type of antibody is involved in type I hypersensitivity reaction?
52. Question: Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)?
53. Question: Which cytokines initiate the production of corticotropin-releasing hormone (CRH)?
54. Question: What is the major concern regarding the treatment of gonococci infections?
55. Question: What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion?
56. Question: Examination of the throat in a child demonstrating signs and symptoms of acute epiglottitis may contribute to which life-threatening complication?
57. Question: The function of the foramen ovale in a fetus allows what to occur?
58. Question: Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve hypoxic spells?
59. Question: Perceived stress elicits an emotional, anticipatory response that begins where?
60. Question: Which term is used to identify the movement of gas and air into and out of the lungs?
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